ARCHITECTURE AND DESIGN


Left: Doctor/Care provider flow. Amy Krause says: “Understanding what each provider does and their typical routes allows us to improve these flows.”


Above: Medicine flow. Often, human delivery is the most efficient and reliable, which requires clear pathways for medicine transport.


areas and unit manager offices are in close proximity for optimal control. Access to utility rooms is centralised to assist with rapid patient response. While it is easier to design from scratch, such as with a greenfield facility, I enjoy the challenge of improving flows in existing layouts – and especially this particular flow. It’s not just about the movement to patient rooms, but also within patient rooms, theatres, or procedure rooms. Understanding what each provider does and their typical routes allows us to improve these flows, ensuring that all regulations and infection control measures are in place. This can be life-changing. Implementing changes in existing facilities, especially


where providers have worked the same way for 30 or more years, can be more challenging than meeting regulations. However, this is what inspires me as a designer: making change understandable and easy to adapt to.


4: Medicine flow The flow and access to pharmaceuticals and other necessary medicines within a facility can sometimes be quite distant for certain units. Some facilities use pneumatic tube systems to transport prescriptions and deliver medication, but these come with their own challenges. In South Africa, load shedding often leads to prolonged power outages. While all facilities have generators (as required by regulation), these may only support essential services, and tube systems may not be included. Often, human delivery is the most efficient and reliable, which requires clear pathways for medicine transport. The placement of the pharmacy is critical. Ideally,


it should be on the patient’s exit route for convenient medication collection, but its proximity to the units it supplies is also important. Each unit type has a specific process for medical storage, governed to some extent by the pharmaceutical council. However, only the main pharmacy designs are submitted for approval. Most units have a clean utility (sterile store/medicine


room), which is always central and visible from the nurse station. These rooms are temperature-regulated, and may have specific layouts and requirements. In our more critical units – such as critical care, neonatal, delivery, and theatre, schedule 5 and 6 drugs are stored in cupboards at the nurse station.


5: Information flow Information flow refers to the movement of patient data, medical records, and other important information. This area is often overlooked or misunderstood. From the moment a patient is booked for a procedure, or assessed at the emergency centre, the information flow begins. Currently, this flow is largely manual, whether by hand or computer, and can be time-consuming. As more facilities across Africa become electronic, I am always amazed at the background work required for this transition – not just training and change management, but also the unseen groundwork by users. While I believe this is the way forward, most facilities I have worked in still use a combination of manual and electronic record-keeping. Patient information is captured electronically, printed


on stickers, and carried in a patient file. This file is confidential. Once the hospital stay is complete, the file is handed to Administration, where all handwritten information is captured online and files are stored. Regulations require files to be stored for between 8 and 21 years. Most facilities have on-site archives for recent cases, but after a few years, files are moved off site for secure storage.


6: Supply flow Supply flow refers to the movement of general supplies, such as linens, cleaning materials, and other consumables. I map out this flow in detail for every facility, though it is often left until last. The amount of storage required is determined not only by the facility’s size, number of beds, and type of procedures, but also by its accessibility to services and supplies. Outlying areas may need larger storage to minimise costly supplier trips. The design of laundries, central


cleaners’ stores, and kitchens, is critical. These spaces should be designed for efficient storage


August 2025 Health Estate Journal 25


The phrase ‘family heals faster’ highlights how supportive family relationships can positively impact recovery from physical and emotional injuries or illnesses, the author maintains.


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